(DOC), length of hospital stay (LOS), blood loss, cost and operative time were also assessed. RESULTSBoth groups showed a significant increase in mean ( SD ) maximum urinary flow rate from baseline ( P < 0.05); in the TURP group from 8.9 (3.0) to 19.4 (8.7) mL/s (154%), and in the PVP group from 8.8 (2.5) to 18.6 (8.2) mL/s (136%). The International Prostate Symptom Score (IPSS) decreased from 25.4 (5.7) to 10.9 (9.4) in the TURP group (53%), and from 25.3 (5.9) to 8.9 (7.6) in the PVP group (61%). The trends were similar for the bother and Quality of Life scores. There was no difference in sexual function as measured by Baseline Sexual Function Questionnaires. The DOC was significantly less in the PVP than the TURP group ( P < 0.001), with a mean (range) of 13 (0-24) h vs 44.7 (6-192) h. The situation was similar for LOS ( P < 0.001), with a mean (range) of 1.09 (1-2) and 3.6 (3-9) days in the PVP and TURP groups, respectively. Adverse events and complications were less frequent in the PVP group. Costs were also 22% less in the PVP group. CONCLUSIONSThis trial shows that PVP is an effective technique when compared to TURP, producing equivalent improvements in flow rates and IPSS with the advantages of markedly reduced LOS, DOC and adverse events. A long-term follow-up is being undertaken to ensure durability of these results. KEYWORDSpotassium titanyl phosphate, laser, prostatectomy, TURP, randomized trial Study Type -Therapy (RCT) Level of Evidence 2b

This trial demonstrates that PVP is effective compared with TURP, producing equivalent improvements in flow rates and IPSS with markedly reduced LOS, LOC, and adverse events. Long-term follow- up is being undertaken to assess the durability of these results.

What ' s known on the subject? and What does the study add? Nurse-led fl exible cystoscopy (NLFC) has developed over the past decade in the UK with reports suggesting that adequately trained nurses can undertake FC competently. However, this is a relatively new concept in Australia and the feasibility and effi cacy of this initiative in Australia has not yet been reported.We describe the various aspects that need to be addressed to implement a NLFC service in Australia. We have shown that NLFC is a safe and feasible option when established with strong departmental support, training, supervision and adherence to established guidelines. NLFC clinics can provide an effi cient service and excellent continuity of care for patients with bladder cancer. Objective• To present our initial experience implementing a nurse-led fl exible cystoscopy (NLFC) service in a Victorian tertiary hospital and our initial results from that service, as NLFC has developed over the past decade with reports suggesting that adequately trained nurses can undertake FC competently. Patients and methods• We describe the implementation of a NLFC service including approval, funding, nurses ' training, and protocols.• Outcomes of all patients having a NLFC or subsequent interventions were recorded prospectively and analysed retrospectively.• To gauge patients ' response to NLFC, an anonymous feedback questionnaire was administered to 60 consecutive participating patients in the recovery unit.• The effect of NLFC on waiting times was determined from surgical scheduling records. Results• In all, 272 patients had 720 NLFC done over a 2-year period. In all, 150 (21%) FCs had a suspected bladder cancer recurrence and were referred for a rigid cystoscopy. Of those, 83 (58%) revealed a recurrence comprising of 14 (17%) high-grade lesions, 45 (54%) low-grade lesions and 24 (29%) were diathermied without a biopsy. In all, 41 (27%) had benign pathology on biopsy and 21 (14%) had normal rigid cystoscopy.• There were two signifi cant adverse events.• There was a 65% reduction in the waiting list for surveillance FC after introduction of the service.• Of 60 patients who completed the feedback questionnaire, 95% reported that they were given enough information by the nurses, 92% had all their questions answered satisfactorily and 97% had enough confi dence and trust in the nurse. In all, 90% had a positive perception of the service overall and 93% were happy to have a FC performed by a nurse rather than a doctor. Conclusions• Results from our NLFC audit compare favourably with other published reports. NLFC is a safe and feasible option when established alongside strong departmental support, comprehensive nurses ' training according to established guidelines, service supervision by a designated consultant and regular audits.• NLFC clinics can provide an effi cient service and excellent continuity of care for patients with non-muscle-invasive bladder cancer.